Suvremeni pristup u liječenju mioma

Miomi su najčešći dobroćudni tumori maternice u žena reproduktivne dobi. Obzirom na broj, lokalizaciju i veličinu uzrokuju simptome poput obilnog produženog krvarenja, bolova i pritiska u zdjelici i okolnim organima te neplodnosti. Zlatni standard u dijagnostici je ultrazvuk. Liječenje može biti medikamentozno, operativno i radiološko. Medikamentozno liječenje uključuje hormonsku terapiju kao preoperatvinu pripremu, a najznačajniji su analozi GnRH i selektivni modulatori progesteronskih receptora (SPRM). Predstavnik SPRM-a, ulipristal-acetat pokazuje vrlo dobre, dugotrajnije rezultate liječenja, sa manje nuspojava u odnosu na analoge GnRH. Operativne metode jesu miomektomija i histerektomija. Miomektomija je poštedniji operativni zahvat, indiciran i kod žena koje planiraju trudnoću, dok je histerektomija radikalni zahvat kojim se u potpunosti uklanjaju simptomi uzrokovani miomima. Laparoskopskom tehnikom postiže se manja postoperativna bol, kraće trajanje hospitalizacije, bolji kozmetički učinak i brži povratak svakodnevnim aktivnostima. Minimalno invazivne tehnike poput embolizacije uterine arterije, ablacije mioma fokusirajućim ultrazvučnim valovima pod kontrolom magnetske rezonancije i radiofrekventna volumetrijska termička ablacija mioma novije su metode koje imaju svoja ograničenja.Myomas are the most common benign uterine tumors in women of reproductive age. Due to the their number, localization and size myomas cause symptoms such as abundant prolonged bleeding, pain and pressure in the pelvis, surrounding organs, and infertility. The gold standard in diagnosis is ultrasound. Treatment may be medical, surgical and radiological. Medical treatment includes hormone therapy as a preoperative preparation, the most significant are GnRH agonists and selective progesterone receptor modulators (SPRMs). Representative of SPRM, ulipristal acetate shows very good, long-lasting treatment results, with fewer side effects compared to GnRH analogs. Surgical techniques are myomectomy and hysterectomy. Miomectomy is conservative surgical procedure, indicated also in women who want to conceive. Hysterectomy is a radical procedure that completely removes symptoms caused by fibroids. Laparoscopic technique achieves lower postoperative pain, shorter hospitalization time, better cosmetic effect and faster return on daily activities. Minimally invasive techniques such as uterine artery embolization(UAE), highfrequency magnetic resonance-guided focused ultrasound surgery (MRgFUS), and radiofrequency volumetric thermal ablation (RFVTA) are new methods but day by day with less limitations